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Biliary Tract Disorders in Elderly

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Biliary tract disorders are recurrent abdominal discomfort associated with gallstone conditions in stable, non-risk patients in old people.

Written by

Swetha. R.

Medically reviewed by

Dr. Jagdish Singh

Published At December 22, 2023
Reviewed AtDecember 22, 2023

Introduction

The liver, gallbladder, and system of ducts that transport bile from the liver to the small intestine comprise the complicated biliary tract. Biliary tract disorders encompass a range of conditions that affect this system, disrupting the flow and function of bile. Elderly people are more susceptible to these disorders due to factors such as bile composition changes and increased risk of gallstones.

What Are the Classifications of Biliary Tract Disorder and Its Definition?

A collection of illnesses known as biliary tract disorders impact the ducts and organs in control of producing, storing, and moving bile. The digestive fluid known as bile is created by the liver and kept in the gallbladder, which is essential for emulsifying and absorbing dietary fats. Biliary tract disorders encompass a range of conditions that can disrupt the normal functioning of these organs and ducts, leading to various symptoms and complications.

Classification Of Biliary Tract Disorder:

1. Gallstones:

The gallbladder is responsible for producing gallstones, which are solid particles. In the elderly, the risk of gallstone formation increases with age. The size of the stone can vary and may obstruct the flow of bile or the cystic duct, leading to pain and other symptoms.

2. Biliary Colic:

Biliary colic is when gallstones or sludge in the gallbladder cause intermittent, severe pain in the upper abdomen. Elderly individuals may experience biliary colic when gallstones move within the gallbladder.

3. Cholecystitis:

Cholecystitis is the inflammation of the gallbladder, often caused by gallstones blocking the cystic duct. It can produce symptoms such as severe abdominal pain, fever, and nausea.

4. Choledocholithiasis:

Choledocholithiasis occurs when gallstones migrate from the gallbladder into the common bile duct, obstructing bile flow. It is also responsible for producing jaundice and other complications in the elderly.

5. Primary Sclerosing Cholangitis (PSC):

PSC is a chronic inflammatory disease that affects the bile ducts, leading to scarring and narrowing. The management of this disease is difficult and may progress to serious complications like cirrhosis and bile duct cancer.

6. Biliary Strictures:

Biliary strictures are abnormal narrowing of the bile ducts, which various factors, including inflammation, trauma, or prior surgeries, can cause. Strictures can lead to bile flow problems and related symptoms.

What Could Be the Symptoms of Biliary Tract Disorders in the Elderly?

Pain is typically felt in the upper right quadrant of the abdomen and can be constant. It may be described as sharp, cramp-like, or aching. The elderly may experience nausea and vomiting episodes, especially after eating fatty meals or during episodes of biliary colic. Jaundice is determined by the change of color in the skin into yellow and the whites of the eyes. It occurs when bile flow is obstructed, leading to the accumulation of bilirubin in the bloodstream.

Jaundice is a common symptom in choledocholithiasis and other conditions that affect the bile ducts. Dark, tea-colored urine can indicate biliary tract disorders, particularly when bilirubin is elevated due to blocked bile flow. Stools may become pale or clay-colored due to reduced bilirubin reaching the intestines. This can be a sign of bile duct obstruction. They may experience bloating, gas, and general discomfort after meals.

In cases of cholecystitis (inflammation of the gallbladder) or biliary infections, elderly patients may develop a fever and experience chills. Itching of the skin is another symptom associated with elevated bilirubin levels due to obstructed bile flow. Difficulty digesting and tolerating fatty foods can be common in elderly individuals with biliary tract disorders, particularly when the gallbladder is affected. Unintentional weight loss can occur in cases of advanced biliary tract disorders, particularly those involving malignancies. Biliary colic refers to episodes of severe, cramp-like abdominal pain. These episodes can be triggered by the movement of gallstones within the gallbladder.

What Is the Diagnostic Procedure for Biliary Tract Disorder?

Tenderness in the upper right abdomen, jaundice, or signs of inflammation are confirmed by the examination(physical). Blood tests that detect liver enzymes, bilirubin, and other chemicals to evaluate the health of the liver and bile ducts are known as liver function tests. Complete blood count tests can help identify signs of infection or inflammation.

Elevated levels ( Amylase and lipase levels) may indicate pancreatitis, which can be related to biliary tract disorders. Abdominal Ultrasound is a non-invasive imaging technique often the first step in diagnosing biliary tract disorders. It can help identify gallstones, assess the gallbladder, and visualize the bile ducts.

Computed Tomography Scan may be used to provide more detailed information about the gallbladder and bile ducts and evaluate for complications. Magnetic Resonance Imaging can provide high-resolution images of the biliary system, helping to detect abnormalities in the liver, gallbladder, and bile ducts.

Hepatobiliary Iminodiacetic Acid Scan is a specialized nuclear medicine scan that can assess the gallbladder's function and evaluate for bile flow abnormalities. Endoscopic Retrograde Cholangiopancreatography test occurred by combining endoscopy and X-ray to visualize the bile ducts. It can also remove gallstones and place stents to relieve obstructions. Endoscopic Ultrasound can provide high-resolution images of the pancreas, bile ducts, and surrounding structures.

Percutaneous Transhepatic Cholangiography is an interventional radiology procedure that involves injecting contrast dye directly into the bile ducts to obtain X-ray images. It is used when ERCP is not possible or has failed. In cases where biliary tract disorders have led to liver damage or cirrhosis, a liver biopsy may be performed to assess the extent of liver injury and to determine the underlying cause. In cases where cancer is suspected, specific blood tests, such as CA 19-9, may be performed to assess tumor markers associated with biliary tract cancers. Cholecystokinin-stimulated hepatobiliary Scintigraphy scan can be used to evaluate gallbladder function and assess for chronic gallbladder disease, particularly in cases of biliary dyskinesia.

How to Manage Biliary Tract Disorder Therapeutically?

Encourage a low-fat diet to reduce the risk of gallstone formation and reduce symptoms. Avoiding spicy foods and excessive caffeine can also help manage symptoms. Promote weight loss for overweight individuals, as obesity is a gallstone risk factor. However, weight loss should be gradual to avoid gallstone-related complications. Non-prescription pain relievers, such as acetaminophen, may help manage mild pain associated with biliary colic. Ursodeoxycholic acid (UDCA) can be prescribed to dissolve small cholesterol gallstones in the gallbladder, although this process can take several months. Antibiotics are used to treat bacterial infections associated with the biliary tract.

The Endoscopic Retrograde Cholangiopancreatography (ERCP) procedure removes gallstones from the common bile duct, places a stent to relieve obstructions, or performs sphincterotomy to improve bile flow. Cutting the sphincter of Oddi during ERCP can help alleviate obstruction and improve bile flow. The gallbladder is removed surgically, and this process is called Cholecystectomy, a common treatment for gallstones and related conditions such as cholecystitis. Percutaneous bile drainage can help decrease symptoms and control infections in obstructive jaundice or biliary sepsis.

Liver transplantation may be considered for patients with advanced biliary tract disorders, such as primary sclerosing cholangitis (PSC) leading to cirrhosis. In cases of biliary dyskinesia, treatment may involve cholecystectomy to remove the gallbladder when the symptoms are severe. If malabsorption due to bile flow problems leads to nutritional deficiencies, dietary supplementation may be required to ensure adequate nutrient intake.

Conclusion

Healthcare professionals should carefully monitor and evaluate older individuals with biliary tract problems since effects can sometimes develop slowly and without visible signs. Seniors with biliary tract problems can live longer and feel better with the help of early diagnosis and individualized treatment options.

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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology

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older adultsbiliary diseases
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